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General Info

When are you available to start?:
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Are you 18 years or older?:
Are there hours or days of the week when you cannot work?

Personal Information

Currently Employed?:
May we contact your current employer:

Have you applied to Primera Plastics before?
When did you previously apply to Primera Plastics?
What name did you previously apply to Primera Plastics with?

Have you graduated elementary school?:

Secondary school completed:



Have you attended college?:

Have you attended other specialized training?:

Do you have military experience?:
Date entered military:
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Date discharged from military:
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Were you honorably discharged?:

Are you lawfully entitled to be employed in the United States?

Have you ever been convicted of a crime other than a minor traffic violation?

Please provide state citation, date, and any other details of criminal history we should be aware of.

Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel may be helpful to us in considering your application:

Employment History

1. Employment Info

Employed from:
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Employed to:
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Additional Info. Last position held, responsibilities, wage, etc.
Reason for leaving, etc.

2. Employment Info

Employed from:
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Employed to:
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Additional Info. Last position held, responsibilities, wage, etc.
Reason for leaving, etc.

3. Employment Info

Employed from:
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Employed to:
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Additional Info. Last position held, responsibilities, wage, etc.
Reason for leaving, etc.

4. Employment Info

Employed from:
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Employed to:
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Additional Info. Last position held, responsibilities, wage, etc.
Reason for leaving, etc.

Contacting Previous Employers

May we contact the employers listed?:
*Employers specifically excepted

References

Reference 1 Info. Relationship, years known, etc.
Reference 2 Info. Relationship, years known, etc.
Reference 3 Info. Relationship, years known, etc.

Upload Files

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Please Read the Following Statement Carefully


I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform Primera Plastics, Inc. prior to the administration of the test so that a reasonable accommodation can be made. Primera Plastics, Inc. reserves the right to require medical documentation regarding the need for accommodation.

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application may result in termination.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice.

I authorize investigation of all statements contained in this application for any employment related purpose. I release the listed references and all employers, *except those specifically excepted (above)*, to provide you with any and all information they may have. I hereby release these references and former employers from all liability for any information they may give you.